Sex-differential and non-specific effects of routine vaccinations in a rural area with low vaccination coverage: an observational study from Senegal
Sex-differential and non-specific effects of routine vaccinations in a rural area with low vaccination coverage: an observational study from Senegal
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DOI：
10.1093/trstmh/tru186
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发表时间：
2015-01-01
影响因子：
2.2
通讯作者：
Trape, Jean-Francois
中科院分区：
文献类型：
--
作者：
Aaby, Peter;Nielsen, Jens;Trape, Jean-Francois
背景资料：我们研究了潜在的性别差异和非特异性的影响，卡介苗（BCG），白喉，破伤风，百日咳（DTP）和麻疹疫苗（MV）在塞内加尔的农村地区。方法：4133名儿童出生在该地区1996年和1999年之间的研究。在三个保健中心提供疫苗接种。通过3个月一次的家访收集疫苗信息。生存分析根据以下接种顺序比较BCG和DTP的效果：BCG优先，BCG+ DTP 1优先或DTP 1优先。我们比较了9个月和24个月之间的DTP和MV，因为9个月是MV的最低年龄。结果：在12个月时，BCG，DTP 1和MV的接种率分别为44%，46%和9%。大多数儿童首先接种BCG+ DTP 1，与未接种疫苗的儿童相比，这种组合与0.69（0.53-0.89）的死亡率比（MRR）显著降低相关。对于接受BCG优先或DTP 1优先的儿童没有任何益处。在未接种疫苗的儿童中，女性-男性MRR为0.79（0.64-0.96），但在接种百白破疫苗的儿童中，女性-男性MRR显著相反，为1.45（1.00-2.10）（同质性检验，p=0.006）。与最近接种MV的儿童相比，同时接种DTP或MV后接种DTP的儿童的死亡率显著更高（MRR=2.59 [1.32-5.07]）。9个月后，接种麻疹疫苗的儿童的男女MRR为0.61（0.31-1.19），但未接种MV的DTP疫苗接种儿童的MRR仍为1.54（1.03-2.31）（p=0.01）。结论：常规疫苗接种顺序对儿童生存的总体影响很重要，这些疫苗与性别差异效应有关。
Background: We examined the potential sex-differential and non-specific effects of bacille Calmette-Gu,rin (BCG), diphtheria-tetanus-pertussis (DTP) and measles vaccine (MV) in a rural area of Senegal.Methods: The 4133 children born in the area between 1996 and 1999 were included in the study. Vaccinations were provided at three health centres. Vaccine information was collected through 3-monthly home visits. The survival analysis compared the effects of BCG and DTP according to the following sequence of vaccinations: BCG-first, BCG+DTP1-first, or DTP1-first. We compared DTP and MV between 9 and 24 months of age, as 9 months is the minimum age for MV.Results: At 12 months the vaccination coverage was 44%, 46% and 9%, respectively, for BCG, DTP1 and MV. Most children received BCG+DTP1-first and this combination was associated with a significantly lower mortality rate ratio (MRR) of 0.69 (0.53-0.89) compared with unvaccinated children. There was no benefit for children receiving BCG-first or DTP1-first. The female-male MRR was 0.79 (0.64-0.96) among unvaccinated children, but was significantly inversed with 1.45 (1.00-2.10) for children receiving DTP vaccination (test of homogeneity, p=0.006). Children who had received DTP simultaneously with MV or DTP after MV had significantly higher mortality (MRR=2.59 [1.32-5.07]) compared with children having MV-only as their most recent vaccination. After 9 months, the female-male MRR was 0.61 (0.31-1.19) for measles-vaccinated children but remained 1.54 (1.03-2.31) for DTP-vaccinated children who had not received MV (p=0.01).Conclusions: The sequence of routine vaccinations is important for the overall impact on child survival and these vaccines are associated with sex-differential effects.